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Home My WebLink About04-09-09 (2)15056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Coun Code Year File Number Bureau of Individual Taxes b Po Box 28oso1 INHERITANCE TAX RETURN Harrisburg, PA1712e-osot RESIDENT DECEDENT 21 ! ; 08 0716 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 180-14-1789 07/01/2008 j 12/31/1921 i Decedent's Last Name Suffix Decedent's First Name MI - ~-- ~--~ ~; Heineman ~ I Louise I J (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spou_ se's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE _ REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ,„„,,., 1. Original Return ~~; 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) ,_„„, 4. Limited Estate ~ 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) .°~ 6. Decedent Died Testate L,.,„.`', 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Wili) (Attach Copy of Trust) ~~ 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number ~ Ronald E. Johnson, Esq i ~ ! (717) 243-0123 F' N If A I' I irm ame ( pp scab e) ;Andrews & Johnson --- First line of address 78 West Pomfret Street ~_ Second line of address t I City or Post Office State ZIP Code _.:,, _ „_,f 'T.::-, ':; ~ ~~~ ~~ -~ _.~ _:._7 Carlisle ~ PA .,17013 '~ ~ ~, * ~'~ ~, Corespondent's a-mail address: rejohnSOn@pa.net -•-~.__ Under penalties of perjury, I declare ave examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration reparer other than the personal representative is based on all information of which preparer has any knowledge. NATURE OF E L FO ~ LIB RETUR~ ~ AT~~/ ADDRESS V " ~ -'-"~ - ~ ~ c/o 78 West Pomfret S e arlisle, PA 17013 ,11~~~E ~~~R ESENTATIVE y~~0 78 West Street, Carlisle, PA 17013 15056051058 SE ORIGINAL FORM ONLY Side 1 15056051058 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's Name: LOUise J Heineman 180-14-1789 RECAPITULATION _,__...~.~..~...~..,~...Y..~.,.,~.~..._....~._.ss....._.._..,..~.._..._ ___e_........ ,~.!.-... ~._..~._..,.ee_,e,..~.._..... 1. Real estate (Schedule A) ............................................. 1. ! 0.00 !; -- - -- - 2. Stocks and Bonds (Schedule B) ....................................... I 2. ; 3,278.58 ': -- - - -- -- .._ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. ~ 0.00 i ---- 4. Mortgages & Notes Receivable (Schedule D) ............................. i 4. j 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. 34.60 j 6. Jointly Owned Property (Schedule F) Separate Billing Requested ....... 6. ; 0.00 ', 7. Inter-Vivos Transfers i£ Miscellaneous Non-Probate Property (Schedule G) _'.~ Separate Billing Requested........ 7. ; 0.00 ota rose Assets total Lines 1-7 .................................... 8. , i 3 313.18 9. Funeral Expenses 8 Administrative Costs (Schedule H) ............. ........ 9. !, 165.00 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ........ ........ 10. ! 0.00 11. Total Deductions (total Lines 9 8 10) ........................... ........ 11. j 165.00 12. Net Value of Estate (Line 8 minus Line 11) ...................... ........ 12. j 3,148.18 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which --- - - - - '-'°'°~°° an election to tax has not been made (Schedule J) ................ ........ 13. ---- 0.00 - _ 14. ____ Net Value Sub'ect to Tax Line 12 minus Line 13 __ ~_ ( ) ................ ........ 14.~~ ~ 3 148.18 ', ~ __.__... TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 taxable at lineal rate X .0 45 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 1 s. 17. 18. 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0.00 141.67 0.00 I 0.00 : 141.67 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: File Number _._. _... 21 08 ` 0716 DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER Louise J Heineman 180-14-1789 STREET ADDRESS 130 Wilson Street CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 141.57 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 0.00 3. InteresUPenalty if applicable D. Interest E. Penalty Total InteresUPenalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 141.57 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 141.57 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the properly transferred :.......................................................................................... ^ ^ b. retain the right to designate who shall use the property transferred or its income :............................................ ^ ^ c. retain a reversionary interest; or .......................................................................................................................... ^ ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ ^ 3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death? .............. ^ ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ ^ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. SCHEDULE B STOCKS AND BONDS ESTATE OF FILE NUMBER Louise J. Heineman 21-08-0716 TOTAL (also online 2, Recapitulation) X3,2773.525 SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANIOUS PERSONAL PROPERTY ESTATE OF Louise J. Heineman Include the proceeds of litigation and the date the proceeds were received by the estate FILE NUMBER 21-08-0716 TOTAL (also online 5, Recapitularion) $34.60 SCHEDULE H A. B. FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES ESTATE OF FILE NUMBER Louise J. Heineman 21-08-0716 Debts of decedent must be reported on Schedule I. ITEM DESCRII'TION AMOUNT NUMBER Funeral Expenses: 1 2 Administrative Costs: 1 Personal Representive Commissions Name of Personal Representative(s) Social Security Number of Personal Representative: Street Address: City: State: Zip: Year(s) commissions paid: 2 Attorney fees to Andrews & Johnson $150.00 3 Family Exemption Claimant Street: City: State & Zip Relationship of Claimant to Decedent: 4 Probate Fees to Register of Wills 5 Accountant Fees to Gerald Brenneman, CPA 6 Tax Return Preparer's Fees 7 Register of Wills - PA Inheritance Tax Return filing fee $15.00 8 9 TOTAL (also online 9, Recapitulation) ~ $165.00 SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Louise J. Heineman 21-08-0716 ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE NUMBER Do Not List Trustee(s) OF ESTATE I TAXABLE D6TRffiVIIONS (iaolude outright apowd dutributiow, ead tnwfen under Sx. 9116(a)(1.2)j 1 Douglas R Heineman son 25% of residue 130 Wilson Street, Carlisle, PA 17013 2 Dale L. Heineman son 25% of residue 31 Longstreet Drive, East Berlin, PA 17316 3 Jane Firestone daughter 25% of residue 1851 Spring Road, Carlisle, PA 17013 4 Carl Heineman son 25% of residue 201 Walnut Street, Carlisle, PA 17013 II NON-TAXABLE DISTRIBUTIONS: A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. Charitable and Governmental Bequests: TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (also enter on line 13, Recapitulation) $0